The Journal of Radiology. Photon 125 (2014) 133-141.
https://sites.google.com/site/photonfoundationorganization/home/the-journal-of-radiology
Original Research Article. ISJN: 5743-8483: Impact Index: 4.89
Ph ton
The Journal of Radiology
Study in fMRI of the stimulation of the auricular areas of the knee as
the French –German and Chinese localizations
David Alimia*, Alfred Geissmannb, Denis Gardeurc , Frank Bahrd
a
Institute Gustave Roussy, Dpt of Auriculotherapy, Villejuif, 94800 France
Centralbahnstrasse 4 CH-4051 Basel, Switzerland
c
Centre RMX 80, avenue Félix Faure 75015 Paris, France
d
Oselstrasse. 25 A 81245 München Deutchland, Germany
b
David Alimi*, Alfred Geissmann, Denis Gardeur, Frank
Bahr receive Photon Young Scientist Award-2014 in
Radiology by Photon Foundation.
Article history:
Received: 15 August, 2014
Accepted: 21August, 2014
Available online: 15 October, 2014
Keywords:
French-German Knee auricular area, Chinese knee
auricular area, Auriculotherapy, fM.R.I, Cartography
accuracy.
Gardeur D.
MD
Bahr F.
MD
Abstract
French-German auricular area is greater than that related
to the Chinese auricular area, which is less specific (more
anterior and superior, sylvien and frontal activation or
more occipital)
Corresponding Author:
Alimi D.*
MD
Email: [email protected]
Citation:
Alimi D., Geissmann A., Gardeur D., Bahr F., 2014. Study
in fMRI of the stimulation of the auricular areas of the knee
as the French –German and Chinese localizations. The
Journal of Radiology. Photon 125, 133-141.
Geissmann A.
MD
All Rights Reserved with Photon.
Photon Ignitor: ISJN57438483D741415102014
1. Introduction
All the power of Auricular therapy is based on
3 fundamental axioms: the accuracy of the
diagnosis,
the
correctness
of
the
corresponding neurophysiological reasoning
and the accuracy of the locations of points.
1.1 Actual maps
Currently, 3 maps are routinely used: 1 in
China (Figure 1), 2 in Europe: a FrancoGerman, established in 1974 by Paul NOGIER
and Frank BAHR and drawn by René
BOURDIOL (Figure 2), a more recent and
established by the school scientific French
University led by David ALIMI and validated by
the World Federation of Chineses Medicine
Societies (Figure 3) (Alimi, 2011). Overall they
overlap all by displaying some shades or
processing differences.
localization and Franco-German localization of
Paul NOGIER and Frank BAHR (the location
of the knee of the scientific University French
School being in agreement with the latter).
1.3 Choice of tool
It seemed interesting, at the suggestion of Pr.
Frank BAHR, to approach scientific highlighted
by a study in functional Magnetic Resonance
Imaging (fM.R.I).
fM.R.I today remains the preferred technique
to capture almost extemporaneously the
cerebral lighting caused by auricular
stimulation. Its spatial (up to 1 mm) and
temporal resolution (1.5 sec), its safety, and
the absence of invasive effect allowing to
certify the neurophysiological action of
Auricular therapy.
1.2 Aim of the study
We have, in this study, particularly interested
in the area of the knee which localization is
somewhat different between the Chinese
Ph ton
133
2. Literature review
Only three former studies have focused on the
demonstration of the correspondences of
auricular zones and their somatotopic cerebral
locations.
2.1 First study
The first (Alimi et al., 2007), demonstrate
neurophysiological connection between thumb
auricular acupoint and somatotopic cerebral
location.
2.2 Second study
The second study (Liboni et al., 2007)
reproduces exactly the first and has been
done by the group of Liboni in Turin, Italy and
find the same results.
2.3 Third study
And the last one (Romoli et al., 2014) focusing
on two auricular zones (thumb auricular
acupoint and brain stem auricular acupoint),
demonstrate again exact correlations between
the ear acupoints and their corresponding
cerebral locations.
3. Justification of research
One of the difficulties of Auricular therapy is to
have the broadest consensus on the exact
location of the points. . There is currently a
discussion between Europeans, Americans
and Chinese, particularly regarding the
location of the area of the knee. This is very
important, both for the community of the
auriculotherapists, as for the effectiveness and
appropriateness of treatments. On the other
hand it is essential for research, education and
publications, that baseline data are consistent
and international. It is the credibility of this
discipline, both physicians and patients. This
research fits into this perspective and was
made in the logical continuation of those we
conducted previously.
4. Objective of research
We want to make, using scientific arguments,
using the tools of modern neuroimaging,
necessary details concerning the exact
location of the area of the knee to the ear. The
choice of fMRI we was dictated by the patient
safety and quality of the results obtained by
this technique: absence of irradiation,
resolution space 1 to 3 mm, resolution time 1
to 2 seconds, thereby realizing the best
compromise between spatial resolution,
temporal
resolution,
sensitivity,
dangerousness,
the
repeatability
and
Ph ton
statistical significance. The main objective of
this research is to attempt to scientifically
clarify the area of the knee to the ear.
5. Need
For the sensitivity and the significance of the
results, a sufficient number of patients was
necessary. The sensitivity of the fMRI machine
should be sufficient for a good capture of
records and for their quality. It also took us
study in the smallest unit of time and place,
with the same stakeholders for good
homogeneity of the results. C’est ainsi que
nous avons pu recruter 10 patients, et
bénéficier d’une machine
6. Materials and Methods
6.1 Work plan
For each subject,the order of the records has
been randomized and is as follows: record
sequence brain at rest, cutaneous stimulation
of knee record sequence, sequence of
recording during stimulation of the ear point of
the knee, according to the Chinese localization
then according to the French localization, with
mechanical needle or cryonics needles. All
records were held for 5 minutes, alternating 30
seconds of stimulation, 30 seconds rest and
10 minutes of relaxation.
6.2 Subjects
9 right-handed and one left-handed, healthy
volunteers, 5 men and 5 women, aged 26-72
years, took part in this research. Written
informed consent according to the Vaud Ethics
Committee approval for MR pilot studies was
obtained following a description of the
conditions and the purpose of the study.
6.3 records
The records were made on 28 and 29 of June
2013 at the Institute of Radiology of Dr. Alfred
GEISSMANN in Basel, Switzerland, on a 3-T
MRI Hdxt machine of G.E.M.S (General
Electric Medical System), started in 2006 and
equipped for E.P.I (Echo Planar Imaging). This
instrument was equipped with accurate time
and space resolutions (about 1mm and 1
second).The fM.R.I objective was the increase
of local blood pressure and consumption of
oxygen (B.O.L.D effect : Blood Oxygen Level
Dependent), which reflects hyper oxygenation
hyperemic related to neuronal activities
without any radioisotope injection. To perform
the stimulations of the study areas, we used
two types of tools: either mechanical needles
(non-magnetic) single use, heart of copper and
copper coating type ESIN
134
(0.4 mm in diameter, 25 mm in length) pricked
in areas of study, either a Cryospray of a
special liquid nitrogen injected into these same
areas, through a system that we have
developed (C.A.T), used by the French
academic school as a new auricular
stimulation tool, and achieving the same
stimulation.
6.4 Stimulated points.
In
the
International
Auriculotherapy
Nomenclature, the tested areas were for the
Chinese zone, with coordinates: D 5, and for
the French-German zone with coordinates: E
4. (Figure 4)
Figure 1:
Ph ton
135
Figure 2:
Figure 3:
Ph ton
136
Figure 4:
Figure 5: Records of the cutaneous stimuli of the knee
Ph ton
137
Figure 6: Records of French-German and Chinese auricular knee zones stimulations (1)
Figure 7: Records of French-German and Chinese auricular knee zone stimulations (2)
Ph ton
138
7. Results
7.1 Validate results
All of the 10 records took place in good
conditions, without incident of any kind.
Countless images collected during this study,
submitted to Dr. Denis GARDEUR, who has
made the statistical counting and anatomicfunctional
analysis.
The results obtained have led us a remove the
records of 4 subjects which lacked certain
elements of functional imaging, which did not
rigorous analysis: for KF, lacked the functional
imaging of the activation of the auricular area
of Chinese knee.
for HM and GA, lacked the functional imaging
of activations of the auricular areas of FrenchGerman and Chinese knee. And KJ lacked the
functional imaging of the skin stimulation of the
knee.
Finally, we find, 8 good records for analyzing
the results of functional imaging of the skin
stimulation of the knee, and 6 good records
for discriminate the stimulation of Chinese
and French-German auricular areas of the
knee, 3 with mechanical needles and 3 with
C.A.T,
for correlate
them
with
the
corresponding knee stimulations.
7.2 Stimulations of right knee
Concerning the 8 functional imaging of the
skin stimulation of the right knee: Activation
was temporal in all cases: Bitemporal 5 times
on 8 Unitemporal 3 times on 8. The
predominance was contralateral to 7 times on
8 and unilateral stimulation once on 8.
Posterior temporal topography 7 times 8 and
anterior temporal topography once on 8.
Temporal location T1: 7 times on 8, T2: 6
times out of 8, T3: 1 times on 8 and T4: 1 time
on 8. With perisylvians extensions 3 times 8,
operculars 2 times 8 and occipitals twice on 8.
7.3 Interpretation
All these data are consistent with what we
know of the functioning of the brain
somatotopic maps: bilateral acquisitions with
predominance of the opposite side to the
stimulation, variability statistical of the display
areas, genetically determined, and finally
functional connectivity varies depending on the
history of the experiences of each subject, the
nature of his mental imagery during
stimulation, of the complexity of the
associative fibers and the angle of flexion of
the knee during stimulation; that explains the
extensions.
Ph ton
7.4 Stimulations of right ear areas of knee
Regarding 6 functional imageries of the
stimulations of the right ear areas of knee
(Figure 5) : It has not been found differences
between the stimulations carried out by
mechanical needles and those carried out by
the cryonics needles.
7.5 Stimulations of right auricular French-German
area of knee.
(Figure 6, Figure 7). The cerebral lighting is
made in all cases in the temporal region: 5
times on 6 bitemporal, 1 time of 6 for
unitemporal.
The
predominance
was
contralateral on left side 5 times on 6,
unilateral on right side 1 on 6. Posterior
temporal topography 5 times out of 6 and
temporal anterior 1 time on 6. Temporal
location T1: 4 times on 6, T2: 3 times on 6, T3:
1 time on 6, T4: 1 time on 6. With perisylvians
extensions 2 times on 6, frontal 2 times on 6
and occipital twice on 6. With, generally, an
area of activation more focal than stimulation
dermal of the knee, and with a very focal
character twice on 6.
7.6 Stimulations of the right auricular Chinese
area of knee
(Figure 6, Figure 7).
The cerebral lighting is made in all cases in
the region temporal but not always
predominant: 4 times on 6 bilateral, 2 times
out of 6 in unilateral. The predominance has
always
been
left.
Posterior
temporal
topography 3 times on 6 and temporal anterior
3 times on 6. With perisylvians extensions 4
times on 6, occipitals 3 times on 6 and
operculars 3 times on 6. With, in General, a
zone of activation more larger than French
area, less clearly temporal, more anterior
topography, most often more in high situation,
perisylvian and opercular.
7.7 Correlations analysis.
7.7.1 Correlation of stimulation of the right
auricular French-German area of the knee
versus skin stimulation of the right knee.
Resulting from this stimulation of brain
activation, areas are overall pretty focal.
Correlations of topographies are considered
excellent 4 times on 6 and satisfactory 2 times
on 6 (as a result of a still more focal activation
of these 2 cases). Hence a very satisfactory
specificity.
7.7.2 Correlation of stimulation of the right
auricular Chinese area of the knee versus skin
stimulation of the right knee.
139
Subsequent to this stimulation of brain
activation areas are never excellent in the fact
that they are extended and Multifocal.
Correlations are satisfactory 3 times on 6, but
with extended activation zones, too posterior 2
times and too high operculum 1 time. They are
judged mediocre 3 times 6, because they cut
that vaguely the area of stimulation of the
knee, 2 too high times located and too anterior
(sylvien and frontal) and once too posterior.
Hence much less specificity in half of the
cases.
7.7.3 Correlations French-German auricular
area versus Chinese auricular area
In 5 out of 6 cases the correlation related to
the French-German auricular area is greater
than that related to the Chinese auricular area,
which is less specific (more anterior and
superior, sylvien and frontal activation or more
occipital); while covering in all cases, but in a
piecemeal way, the zone of the stimulation of
the knee.
Discussion
This study seems to be interesting in several
respects: This is the first time that is made
such a study of comparative scientific
determination of topography of Auricular
therapy areas, using the fMRI; one of the best
current neuroimaging tools. 2 Areas are
reactive but with similarities and differences:
the cerebral lighting is temporal in both cases,
with a ratio of bilateral or unilateral allocation
substantially
identical
(15%),
which
corresponds to the known neurophysiological
proportions of filling of somatotopics fields.
Extensions exist in both cases, but are more
frequent for the Chinese area (50%) than for
the French-German (33%).These same areas
of extensions are much larger for the Chinese
area for the French-German. Analysis of
correlations allow noted that: The topographic
correlation of the French-German zone is
considered excellent 4 times on 6 and
satisfactory 2 times on 6, while the Chinese
zone is never found to be excellent. It is
satisfactory 3 times on 6 (but extended, too
high and too posterior operculum); and poor 3
times on 6, cutting that incompletely
stimulation knee, located too high and too
anterior or posterior area. The correlation of
accuracy of the French-German zone is
considered to be rather focal, the Chinese
zone rather vague, incomplete, too imprecise.
Ph ton
Conclusion
The Chinese area covers in all cases the area
of skin activation of the knee but way
piecemeal, incomplete, too vague and less
specific than the French-German area way;
which the precision and specificity are instead
more than satisfactory, giving to this area a
largest superiority 5 times 6.
We believe that these differences may find an
explanation in the fact that, in the international
Nomenclature of Auriculotherapy, French
auricular mapping attributes to the Chinese
area of the knee (D 5), the representation of
the leg. However, in brain mapping, the
projections of the leg and the knee are 2 areas
of the same brain segment level (Penfield et
al., 1937); what can explain the large zones
recorded and frequent extensions consecutive
to the stimulation, as well as the lack of
precision. This Chinese auricular zone could
very well represent the region of the leg with
the linked knee, while the French-German
auricular zone would be more specific of the
knee itself.
Beyond these details, this new study validates
again the concept of neurophysiological links
between representations of Auriculotherapy
areas on the Auricular pavilions and brain
somatotopics maps. In a previous study of
fMRI (Alimi et al., 2007), we had already
shown
the
existing
neurophysiological
connections between the auricular area of the
thumb and brain. The area of the thumb and
that of knee being very remote into the brain
somatotopics geographies, and these zones
having their strength through their Hebbian
organization (Wlodzislaw., 2000); this other
evidence strongly confirms the operating mode
of Auricular therapy that make of each ear the
touch screen of the opposite cerebral
hemispheres.
Research Highlights
Neurophysiological connections
This new research illustrates once more the
existence of neurophysiological connections
between the auricular keyboard and the
cerebral hemispheres.
Sunrise of uncertainty
This scientific determination of the zone of the
representation of the knee to the ear will lift the
existing uncertainty to this day.
140
Therapeutic details
Finally, the result of this research will increase
the Auriculotherapy relevance in diseases of
the knee.
Limitations
FMRI is a wonderful tool for the study of the
brain functions both anatomical as functional,
and based on the bold effect (blood oxygen
level
dependency),
reflecting
the
proportionality of the response to the hypo
oxygenation of venous flow, after activation of
groups of cortical neurons. But it is true that
one is never sure registration obtained on the
MRIs is a direct reflection of the peripheral
stimulation. Indeed, on the one hand, the brain
functions are the result of activations of
networks of neurons and astrocytes, and on
the other hand, it is rare that the
vascularization of the registered areas be
terminal-type. These facts constitute a
limitation of the veracity of the data of fMRI.,
but mitigated by the reproducibility of the data
and
their
consistency
with
the
neurophysiology. On the spatial and temporal
resolutions, constitute for us a very acceptable
limit, because in most cases, it is rather
anatomo-functional studies. He does that in
the current knowledge, fMRI is still one of the
best tools for the study of neuro-functional
characteristics of the brain.
Recommendations
We believe that we must continue
characterization studies of Auricular therapy
with the fMRI tool and its technical
improvement points, with as many topics as
possible to minimize biases or deficiencies.
However if it appeared that another technique
became greater than fMRI, while keeping its
qualities, it will not hesitate to use it.
Authors’
Interests
Contribution
and
Competing
The Authors declares that there is no conflict
of interests regarding the publication of this
paper.
Funding/Support
This study was possible due to research funds
from the
EuropäischeAkademiefür TCM,
Vorsitzender Prof. mult. h. c./ China. Dr. Med.
Frank R. Bahr. München, Deutschland.
Ph ton
Aknowledgements
Dr David Alimi thanks:
Pr Frank BAHR and his Association
(EuropäischeAkademiefür TCM) for having
provided research funds.
Mrs. Emilie GERARD and Sophie BUTSCHA,
Technicians and Mr. Franck GIRARD,
Physicist, for their help and their wise advices.
Geographical coordinates
This study was conducted ,
Switzerland, In Europe, in 2013.
in
Bazel,
References
Alimi D., Geissmann A., Gardeur D., 2002.
Auricular Acupuncture Stimulation Measured
On Functional Magnetic Resonance Imaging.
Medical Acupuncture, 13(2), 18-21.
Desclée D., B. (Editor) 2011; International
Chinese and French Normative Nomenclature
of Fundamentals terms and expressions of
Chinese Medicine, ISBN : 978-2-220-06330-0.
Liboni W., Romoli M., Allais G., 2007. et al.
The fMRI for the auricular acupuncture
validation:
Experimental
protocol
(presentation; in Italian). Acti XXII Congresso
Nationale Soc Ital Rifles Ago Auri (SIRAA):
November, 16-17.
Penfield W., Boldrey E., 1937. Somatic motor
and sensory representation in the cerebral
cortex of man as studied by electrical
stimulation. Brain, 60, 389-443.
Romoli M., Allais G., Airola G., Benedetto C.,
Mana O., Giacobbe M., Pugliese A.M.,
Batistella G., Fornari E., 2014. Ear
acupuncture and fMRI : a pilot study for
assessing the specificity of auricular points.
Oral Communications, Springer. (Editor)
Neurological Science, DOI 10.1007/s10072014-1768-7.
Talairach J., Tournoux P., 1988. Nex York
Thieme Medical Publishers (Editor) 1988;Coplanar Stéréotaxic Atlas of the Human Brain.
Wlodzislaw D., 2000. Department of Computer
Methods, Nicholas Copernicus University,
Torun, Poland.
141